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Furanyl fentanyl, a powerful synthetic opiate similar to heroin, was found in 10 recent drug-related deaths in Milwaukee County, the Milwaukee Journal Sentinel reports. The substance is a variation of fentanyl that can be legally prescribed by a doctor but can be 40 to 50 times more powerful than heroin and can be extremely deadly. Furanyl fentanyl was first identified in Milwaukee County last year, but it’s possible it has shown up before without detection. The county’s toxicology lab began routinely screening for that variation last year, said the lab’s Sara Schreiber.

The lab first saw fentanyl, then a rise in acetyl fentanyl and now more furanyl fentanyl, she said. “Generally, it’s hard to keep up because things are always changing,” she said. “The trends are changing. This seems to be the one that’s hot right now.” Furanyl fentanyl began cropping up more frequently in the U.S. after China banned 100 synthetic drugs, including acetyl fentanyl, in 2015. U.S. authorities added it as a Schedule 1 drug last year after at least 128 deaths were tied to it nationwide. Experts believe that fentanyl produced in Chinese labs is fueling its abuse in the U. S. and other countries.